Contract Definition Analyst

We are looking for Contract Definition Analyst for our client in Atlanta, GA.

Job Title: Contract Definition Analyst

Job Location: Atlanta, GA

Job Type: Contract

Job Overview:

• The Hospital Contract Definition Analyst plays a critical role in the implementation and maintenance of hospital payer contracts within the Contract Manager system.
• This position ensures accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates.

Requirement/Must Have:

• High School diploma or G.E.D. required.
• Bachelor s degree in Healthcare Administration, Finance, Accounting, or Business Administration preferred.
• Total 8 -10 years of experience.
• Minimum of 4 years experience in the hospital industry, with direct involvement in payer contracts, facility reimbursement methodologies, and adjudication rules.

Responsibilities:

• Uses extensive knowledge of reimbursement methodologies to analyze, define, and maintain hospital payer contracts including Medicare, Medicaid, Workers Compensation, and Commercial Payers using the Contract Manager software.
• Analyze and interpret complex contract provisions and reimbursement rates submitted by clients to identify all necessary terms for accurate system configuration.
• Research payer websites and regulatory sources to stay current on adjudication rules and reimbursement policies.
• Validate and troubleshoot system-generated valuations against client-submitted claims and estimates, reconciling discrepancies due to data entry errors or policy interpretation.
• Ensure contract terms are accurate and implemented in alignment with client intent and payer agreements.
• Respond to valuation-related support cases within defined Service Level Agreement timeframes.
• Participate in internal and client meetings to support project alignment and issue resolution.
• Contribute to process improvement initiatives aimed at reducing manual effort and enhancing data accuracy.

Nice to Have:

• Familiarity with hospital billing, claims management, and payer contracting.
• In depth knowledge of facility reimbursement models used by commercial payers, Medicare, and Medicaid for both inpatient and outpatient services.
• Proficiency in coding systems including CPT, HCPCS, DRG, Revenue Codes, Occurrence Codes, ICD-10 Diagnosis and Procedure Codes.
• Strong analytical, deductive reasoning, and problem-solving skills.
• Ability to adapt and learn new and changing reimbursement methodologies and underlying logic in a fast-paced environment.
• Excellent communication and customer service abilities.
• Advanced proficiency in Microsoft Office, especially Excel.
• Ability to work independently under tight deadlines in a fast-paced environment.
• Demonstrated commitment to accuracy, timeliness, and continuous learning.